ENCORE: Smartphones, social media and poor mental health

On this episode, Dr. Blair Bigham and Dr. Mojola Omole explore two articles in CMAJ focused on the critical importance of trust in the health care system. They speak with Louis Lochhead, who shares his experiences navigating the health care landscape as a caregiver after his wife's serious accident, which resulted in a coma lasting nearly two months. Lochhead highlights the difficulties in building trust with the medical team, pointing to challenges in communication and empathy. He recounts moments where the lack of clear, compassionate communication from health care providers compounded the stress and uncertainty of the situation, leaving him feeling isolated and disconnected from the decision-making process regarding his wife's care.

Next, Dr. Omole and Dr. Bigham speak with Dr. François Lamontagne, an intensive care specialist, who offers insights into how health care professionals can better connect with families and build trust, especially when faced with uncertain diagnoses or prognoses. He emphasizes the importance of acknowledging the inherent unpredictability of medicine and the value of being transparent about known facts and areas of ambiguity. Dr. Lamontagne suggests that by engaging in open, honest dialogues that respect the family's perspective and concerns, health care providers can create a more supportive environment that encourages shared decision-making. This approach not only helps in building trust but also empowers families during challenging times, making them feel valued and part of their loved one's care journey.

This podcast has been sponsored by MD Financial Management. Click here for more information. 

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode of the CMAJ Podcast, Dr. Catherine Varner, deputy editor of CMAJ, sits in for Dr. Blair Bigham and joins Dr. Mojola Omole to explore two articles published in the journal that highlight troubling findings concerning the treatment of opioid use disorder.

They begin with a study that revealed significant gaps in treatment for opioid overdose patients, where only 5.5% received opioid agonist therapy within a week of their hospital visit. This comes five years after the release of guidelines for opioid use disorder management in Canada, which recommended starting opioid agonist therapy, specifically Suboxone, in patients with opioid use disorder. One of the paper’s co-authors, Dr. Jessica Kent-Rice, a PGY5 resident in emergency medicine and toxicology fellow at the University of Toronto, dissects the complexities of treating opioid use disorder in the emergency department and makes a passionate plea for physicians to increase their prescriptions of these life-saving therapies.

Transitioning to the second article, the hosts examine the presence of xylazine, a veterinary sedative, in the illicit opioid supply. Dubbed the "zombie drug" due to its effects on people's skin and prolonged effects during overdose, xylazine is raising alarm bells among emergency physicians. However, the article's co-author, Dr. Peter Wu, an internist and clinical pharmacology and toxicology physician at the University Health Network in Toronto, advocates for a balanced response. He cautions against excessive concern, noting that treatment continues to revolve around providing supportive care.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole examine an article published in CMAJ titled, 'Tackling barriers to Canadian medical school admissions for students with disabilities.' The analysis highlights how medical education has historically devalued or excluded trainees with disabilities and emphasizes the need for more flexible and inclusive admission processes. 

They are joined by Shira Gertsman, the lead author and a medical student at McMaster University, who shares her personal battle with Crohn's disease and the hurdles she encountered applying to medical school. Gertsman underscores the critical need for accommodations for individuals with disabilities and the importance of greater representation and understanding within the medical field.

Next, the hosts speak with Dr. Caroline Bowman, a family physician who developed multiple sclerosis mid-career, to discuss her initial symptoms, her fears and concerns, and the impact of MS on her ability to work as a family physician. She also talks about the challenges she faced in accepting her disability and the shame associated with it. Dr. Bowman offers her thoughts on how the medical profession can be more accommodating and understanding towards physicians with disabilities, and the benefits that both physicians and patients can gain from addressing shame and creating a more compassionate culture in medicine. The discussion acknowledges how strains in the medical system reduce flexibility and challenge its capacity to make systemic changes.

This podcast has been sponsored by MD Financial Management. Click here for more information. 

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode of the CMAJ Podcast, Dr. Blair Bigham and Dr. Mojola Omole discuss the practice article in the journal entitled, “Five things to know about…Novel obesity treatments". They discuss the impact of new medications like semaglutide and tirzepatide in treating obesity with Dr. Shohinee Sarma, the lead author. Dr. Sarma explains the significant effects these drugs have on weight loss and cardiometabolic health. They also discuss how these treatments can be combined with behavioral therapies for improved results, while considering potential side effects and complications.

Next, Dr. Ashley White, a family physician and diplomate of the American Board of Obesity Medicine, emphasizes the need for a comprehensive approach to obesity management. She stresses the importance of establishing realistic expectations with patients, addressing self-image concerns, and considering the long-term impacts on metabolic health. The conversation also touches on the societal biases and stigmas around obesity, highlighting the necessity for a change in how physicians and society view this medical condition.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode, Dr. Emmanuel Bujold addresses the gross underutilization of acetylsalicylic acid (ASA) in Canada during pregnancy, a treatment highly effective in preventing preterm preeclampsia among those at risk.

Dr. Bujold is an OB-GYN in Quebec City and a professor of Obstetrics & Gynecology at Laval University's School of Medicine. He is a co-author of the commentary in CMAJ entitled, “Screening for preeclampsia risk and prophylaxis with acetylsalicylic acid”.

Dr. Bujold presents evidence showing ASA's effectiveness in preventing more than 80% of severe preeclampsia cases. He advises that high-risk pregnant women take ASA up to 36 weeks of gestation, with ongoing research potentially adjusting this recommendation.

Dr. Bujold describes a simple, relatively inexpensive, and widely available testing protocol that can effectively predict preeclampsia in the first trimester and that starting aspirin before 16 weeks of pregnancy can prevent severe cases.

Next, Dr. Modupe Tunde-Byass, an OB-GYN based in Toronto and the inaugural president of the Black Physicians of Canada, emphasizes the disparities in pregnancy outcomes among racialized communities, particularly the higher rates of morbidity and mortality among Black women. She advocates for the implementation of race-based data collection in healthcare to better understand and address these disparities, highlighting the importance of tailored medical approaches to improve outcomes for these communities.

This podcast has been sponsored by PrescribeIT. Click here for more information.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode, we revisit and update one of the most-read articles on the CMAJ website.

The article is titled, “Smartphones, social media use, and youth mental health.” It reviews the extensive literature linking poor mental health in adolescents with smartphone and social media use. The article details a variety of studies that implicate smartphone and social media use in increased mental distress, self-injurious behaviour, and suicidality among youth. It also indicates that there's a dose-response relationship, with the effects appearing to be most pronounced among girls.

The lead author of the paper is Dr. Elia Abi-Jaoude. He is a psychiatrist and researcher at The Hospital for Sick Children in Toronto. He delves into recent research exploring how social media and smartphone use negatively impact the mental health of young individuals.

Later in the episode, Dr. Michelle Ponti offers practical tips that physicians can provide parents to effectively manage their children's smartphone and social media use. Dr. Ponti is a paediatrician in London, Ontario, and Chair of the Digital Health Task Force for the Canadian Paediatric Society.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode, Drs. Blair Bigham and Mojola Omole discuss the CMAJ paper "Cost-effectiveness of pharmacogenomic-guided treatment for major depression". The paper examines the potential of pharmacogenomic testing in the treatment of major depression and its implications for health care costs.

The study suggests that implementing pharmacogenomic testing for adults with moderate to severe major depressive disorder in British Columbia could save the health system about $956 million over 20 years, equating to roughly $4,926 per patient.

The hosts interview the study's authors, Dr. Jehannine Austin, Professor of Psychiatry and Medical Genetics at UBC, and Dr. Shahzad Ghanbarian, a mathematical modeler and research scientist, also at UBC.

They explain how pharmacogenomic testing can reduce the often lengthy trial and error process of selecting medication for depression. The study demonstrates that this approach facilitates more effective early intervention, potentially reducing the number of patients with refractory depression by 37%. 

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode, Drs. Blair Bigham and Mojola Omole delve into the evolution and advancements in virtual urgent care since the COVID-19 pandemic. The discussion centers around the study published in CMAJ entitled "Healthcare utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care," which analyzed patient usage and outcomes during the height of the pandemic. 

The study didn’t specifically track how many patients were redirected from emergency departments (ED) to virtual care. However, it found that around 80% of patients seen via virtual urgent care didn't require an immediate ED visit, suggesting that virtual care likely reduced some emergency presentations. However, it also noted that virtual urgent care didn't always prevent subsequent hospital visits. Importantly, the study reflects a specific period and doesn't capture the current state of virtual urgent care.

Dr. Justin Hall, director of the Toronto Health Region's Virtual Urgent Care Program, describes how the service has developed since 2020. Key improvements include enhanced technology for a more seamless patient experience and additional capabilities like imaging and laboratory testing. Dr. Hall says the program now acts as a crucial link for patients without regular access to healthcare providers and can successfully address acute, non-life-threatening conditions.

Drs. Bigham and Omole then speak with Mary Dimeo, a nurse practitioner working in the Toronto region's virtual urgent care service. She describes her role and experiences in the virtual environment. Ms. Dimeo says, typically only one patient per day needs to be referred to the emergency department which suggests the service helps divert patients from the hospital, especially those without family doctors or who cannot wait for an appointment.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

On this episode, Drs. Mojola Omole and Blair Bigham speak with two vaccine experts about the necessity, timing and availability of vaccines as we move into the season when influenza, RSV and COVID-19 are on the rise.

Dr. Scott Halperin, co-author of a CMAJ practice paper on SARS-CoV-2 vaccination in pregnancy, emphasizes the importance of vaccination to protect against COVID-19 infection during pregnancy. He notes that while there is awareness among healthcare practitioners, it is crucial to continually highlight and reemphasize the importance of vaccination during pregnancy. The risk of severe outcomes from COVID-19 is higher in pregnant individuals compared to non-pregnant individuals. Vaccination during pregnancy not only protects the mother but also transfers antibodies to the fetus, providing protection in the first few months of life. 

Next, Dr. Trevor Arnason, Associate Medical Officer of Health with Ottawa Public Health, discusses the availability and administration of fall vaccines. He explains that the influenza vaccine is recommended for everyone over six months of age, with a higher dose available for older adults. The SARS-CoV-2 vaccine can be administered at the same time as the influenza vaccine, as there is now sufficient data on its safety. The RSV vaccine, currently approved for individuals over 60, is not government-funded and may not be accessible to everyone. Dr. Arnason emphasizes the importance of getting both the influenza and SARS-CoV-2 vaccines, particularly for high-risk groups such as young children, older adults, and individuals with underlying health conditions.

In summary, both Drs. Halperin and Arnason argue it is crucial for healthcare providers to educate and encourage their patients, especially pregnant individuals, to get vaccinated.

CMAJ article SARS-CoV-2 vaccination in pregnancy

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions

In this episode, Drs. Blair Bigham and Mojola Omole delve into the pressing issue of alcohol use disorder (AUD) in Canada with Dr. Evan Wood, the lead author of the “Canadian guideline for the clinical management of high risk drinking and alcohol use disorder” published in CMAJ. 

They explore the concerning prevalence of AUD in Canada, contrasting it with other countries and shedding light on the diagnostic criteria that underscore the significance of assessing clinically significant impairment or distress.

Dr. Wood clarifies the hurdles faced in identifying and treating AUD, highlighting the shortfall in healthcare provider education and resources. He underscores the importance of routine screening for alcohol use by physicians and offers invaluable tips to improve recognition of this pervasive disorder.

Dr. Wood outlines the recommended pharmacotherapies as stipulated in the guideline. He points out the frequency with which ineffective, or even harmful, treatments are prescribed for mood symptoms related to AUD and calls on physicians to follow evidence-based approaches.

Dr. Wood concludes by emphasizing the necessity of constructing a comprehensive system to tackle alcohol use disorder head-on in Canada, fostering a thorough understanding of this widespread health challenge among the medical community.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

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The CMAJ Podcast is produced by PodCraft Productions